Many high school athletes at greater concussion risk than college counterparts: Report

The Institute of Medicine and National Research Council report that in many sports, high school athletes have a higher risk of getting a concussion than college players.

In a joint report published on Oct. 30 by the research organizations, a panel of medical experts found that concussion rates were higher in high school-aged athletes who played football, baseball, men's lacrosse and men's soccer than for college athletes who play those sports.

For football in particular, college athletes experience an estimated 6.3 concussions per 1,000 athletic exposures, a number that includes all practices and games. High school rates were at 11.2 concussions per 1,000 athletic exposures.

Competitions also yield more concussions than practices, except for in cheerleading. The highest concussion rates during games were seen in football, ice hockey, lacrosse, wrestling, soccer and women's basketball competitive events.

Concussions were also more likely to occur in students with a prior history of concussions and among female athletes. While high school male basketball players suffered 2.8 concussions per 1,000 athletic exposures for example, female player rates were at 5.6 concussions per 1,000 athletic exposures.

Sport concussion rates for female high school and college athletes were highest for soccer, lacrosse, and basketball. Football, ice hockey, lacrosse, wrestling and soccer had the most reported cases concussions for high school and college male athletes. But, collegiate women's ice hockey yielded the most concussions overall.

"The findings of our report justify the concerns about sports concussions in young people," report committee Chair Robert Graham, director of the national program office for Aligning Forces for Quality at George Washington University, Washington, D.C., said in a press release. "However, there are numerous areas in which we need more and better data. Until we have that information, we urge parents, schools, athletic departments, and the public to examine carefully what we do know, as with any decision regarding risk, so they can make more informed decisions about young athletes playing sports."

The number of adolescents 19 and under treated in emergency rooms for concussions and other non-fatal, sports and recreation-related traumatic brain injuries increased from 150,000 in 2001 to 250,00 in 2009, the authors noted. A previous study published in September revealed that ER admission rates for children with sports-related head injuries has increased by more than 90 percent in the last decade.

In the new report, the medical panel discovered that people who suffer from concussions will typically experience at least one physical, cognitive, emotional or sleep-related symptom. Reviewed studies also linked single and multiple concussions to speed issues for memory and processing functions.

The researchers also looked at studies of retired professional athletes. One survey of 2,5000 retired professional players revealed that 11 percent had a prior or current diagnosis of clinical depression. However, the authors noted that the link between concussions and depression has not been well-established.

Youth athletes usually recover from a concussion within two weeks of the injury, but in 10 to 20 percent of the cases the issues stemming from the brain trauma may persist for weeks, months or even years.

The American Academy of Pediatrics (AAP) recently recommended that students who suffer from severe concussions or concussions with symptoms longer than three weeks be kept out of school while they recover, and may need additional academic arrangements upon returning to their classwork. Students should also be back to their prior academic performance before returning to the field.

The new report added that current sports helmet designs did not really reduce the risk of concussions. They noted that this did not mean that athletes should not wear properly-fitted helmets, face masks, and mouth guards. This equipment still can reduce the risk of other injuries, including as skull fractures, bleeding inside the skull and injuries to the eyes, face, and mouth.

The report's authors are concerned that young athletes may be playing in a "culture of resistance" that discourages them from reporting their concussions or continuing with treatment plans. Research presented at the Pediatric Academic Society's annual meeting showed that half of high school football player said that even if they sustained an injury that put them at risk of having a concussionthey would still continue to play. A little less than half said they would not report their concussion symptoms to a coach.

The committee recommended that the Centers for Disease Control (CDC) set up a system to monitor the sports-related concussion rate for young athletes, and the National Institutes of Health and the Department of Defense should fund and pursue studies on concussion diagnosis, age and sex related differences in concussion rates and symptoms, and the effects of concussions and head impacts over the lifetime of an individual.

"Constantly, we came to this place where there's just nothing about kids.... This has to hit home. We have to start doing better studies," co-author Arthur Maerlander, assistant professor of psychiatry at Dartmouth College, told USA Today.

In addition, the authors urged government agencies to create age-specific guidelines for managing concussions. The American Academy of Neurology currently recommends that if a doctor is unsure about the severity of a student athlete's concussion, the player should be kept off the field. This is an update from previous advice, which used to grade the severity of a concussion and the suggest a length of time the athlete should be held out of the game.

The new report's authors also asked the NCAA and the National Federation of State High School Associations to evaluate their rules and techniques in order to reduce sports-related concussion rates, as well as increase their efforts to educate players, their families, coaches, trainers, healthcare professionals and sports officials about concussions.

The study was funded by the Centers for Disease Control Foundation and the NFL Foundation.